2023 GEHA Dental Benefits Guide

Choose from five unique medical plans designed to meet you where you are in life. Download the PDF for a 508-accessible document.

2023 GEHA Dental Plans

Choose from two comprehensive dental plans with a large, nationwide network and worldwide coverage.

geha.com | 877.590.4342

What’s inside

03 Welcome 04 Choose from two dental plans 04 High 04 Standard 05 What’s new in 2023 06 In-network preventive care covered 100% 07 Compare GEHA dental plans 08 Coverage for major dental needs 10 Vision discounts included with both dental plans 11 Included benefits & discounts 12 Step 1: Use your ZIP code to find your rate code 13 Step 2: Use your rate code to find your 2023 premium 14 Definitions 15 Helpful resources

2023 GEHA dental plans

Welcome

Whatever stage of life you are in and whatever your needs, GEHA has a plan for you.

We believe dental care isn’t one size fits all, and our plans are designed with that in mind. For more than 85 years, GEHA (Government Employees Health Association, Inc.) has provided benefit plans designed exclusively for federal employees.

GEHA offers two dental plan options:

Open Season begins on Monday, November 14, and concludes on Monday, December 12. NOV DEC

High

Standard

Both plans include: • Comprehensive dental services, from preventive care to crowns, bridges and dentures • No in-network deductibles and no waiting periods, including orthondontia for children and adults • Worldwide coverage with a large nationwide network. Search our network at geha.com/Find-Care

2023 GEHA dental plans

Choose from two dental plans

High

Get plan details at geha.com/HighDental

Who should consider High dental? • People planning for dental procedures in the near future • Adults and children who want a lower out-of-pocket cost for orthodontic coverage • People with medical conditions that may affect or can be affected by their dental health • People looking for the peace of mind that comes with comprehensive coverage

About this plan: • Includes three dental cleanings per year • Includes an unlimited annual maximum benefit per person • Provides GEHA’s greatest coverage for intermediate and major dental care services • Offers orthodontic coverage for both children and adults, with no waiting period

How often you use your plan:

Low

Average

High

Standard

Get plan details at geha.com/StandardDental

Who should consider Standard dental? • People concerned with their overall health and wellness • People looking for the peace of mind that comes with additional dental coverage beyond what’s included in their medical plan

About this plan: • GEHA’s lowest premium dental plan • Offers orthodontic coverage for both children and adults, with no waiting period • Includes an in-network annual maximum of $2,500 per person

How often you use your plan:

Low

Average

High

This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental

2023 GEHA dental plans

What’s new in 2023

• The Standard dental plan no longer has an orthodontia waiting period for children or adults. • The High plan now offers three dental cleanings per year

Is your provider in-network? Visit geha.com/Find-Care to search our network of more than 400,000 provider locations nationwide.

Need help understanding insurance terms? See page 14 for helpful definitions.

Ready to enroll? Visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. Or call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680

For a complete list of plan changes, download the plan brochure at geha.com/PlanBrochureDental

2023 GEHA dental plans

In-network preventive care covered 100% GEHA’s dental plans offer over 400,000 in-network provider locations nationwide as well as worldwide coverage. Use in-network providers to get the greatest value from your GEHA dental plan. In-network preventive care is covered at 100% . For all other dental services, in-network providers will not bill you more than the agreed-upon fees for covered services.

To find a provider, or to see if your provider is in-network, visit geha.com/Find-Care

Term

Definition

If your out-of-network dentist charges more than GEHA’s agreed-upon fee (plan allowance) for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. If you have a FEHB medical plan with dental coverage, your medical plan will be considered the primary payer for some services before any benefits are paid by your FEDVIP dental plan.

Out-of-network services

FEHB medical plans

Prior orthodontic services

GEHA does not cover cosmetic treatment or orthodontic work in progress (except for orthodontics started under TRICARE).

Did you know? GEHA plans include vision benefits. For more details, see page 10 .

2023 GEHA dental plans

Compare GEHA dental plans

No in-network deductibles and no waiting periods. Compare plans at geha.com/CompareDental

High Dental in-network or out-of-network 1 you pay

Standard Dental in-network you pay

Standard Dental out-of-network 1 you pay

2023 dental benefit

Benefit description

Class A. Covers two exams, two cleanings, and two 2 sets of bitewing X-rays per calendar year

Nothing

25%

Basic

Class A. Covers a third cleaning

Nothing

Basic

No benefit

Class A. One oral evaluation per patient in a 12-consecutive-month period Class B. Covers restorations, extractions and periodontal maintenance Class C. Covers root canals, crowns, bridges, dentures and periodontal surgery 3 Class D. Covers adults and children orthodontic. No waiting periods.

Teledentistry.com

Nothing

No benefit

20%

45%

50%

Intermediate

50%

65%

70%

Major

30% with $3,500 lifetime maximum

50% with $2,500 lifetime maximum

50% with $1,500 lifetime maximum

Orthodontic

Class A, B and C services only

Unlimited per person

$2,500 per person

$2,000 per person

Calendar year maximum

Class B and C services out-of-network deductible is $0 for High, $25 Standard Self Only, $50 Standard Self Plus One and $75 Standard Self and Family. 1 If your out-of-network dentist charges more than GEHA’s agreed-upon plan allowance for a specific service, you are responsible for the difference between the plan allowance and the out-of-network dentist’s charge plus regular coinsurance. 2 Two bitewings covered annually for members 22 and under. One set of bitewings is covered per year for adults ages 23+. 3 Implants are limited to $2,500 per person per year in-network or out-of-network on High. For Standard, implants are limited to $2,500 per person per year in-network, or $2,000 per person per year out-of-network.

2023 GEHA dental plans

Coverage for major dental needs You pay $0 deductible in-network. No waiting periods. GEHA’s plans let you start treatments right away, even when your needs go beyond annual cleanings. Examples of three common major dental services

Orthodontic coverage

Dental implant coverage

Night guard 1 coverage

Coverage type

In-network for High and Standard

You pay your regular coinsurance and/ or any amount that exceeds the lifetime benefit maximum. You pay any charges that exceed the plan allowance, plus any regular coinsurance. You pay any charges that exceed the plan allowance, plus any regular coinsurance.

You pay your regular coinsurance and/ or any amount that exceeds the annual benefit maximum. You pay any charges that exceed the plan allowance, plus any regular coinsurance. You pay the $25 deductible plus any charges that exceed the plan allowance, plus any regular coinsurance. GEHA pays a $2,500 calendar year maximum, per covered member. GEHA pays a $2,500 in-network, $2,000 out-of-network,

High out-of-network

Standard out-of-network

High maximum benefit

GEHA pays a $3,500 lifetime maximum, per covered member.

GEHA pays once per calendar year.

Standard maximum benefit

GEHA pays a $2,500 in-network, $1,500 out-of-network, lifetime maximum, per covered member.

GEHA pays once per calendar year.

calendar year maximum, per covered member.

1 Also known as occlusal guard. This is a brief description of services covered under the GEHA Connection Dental Federal plan. For a complete list of plan limitations and exclusions, please refer to the GEHA Connection Dental Federal plan brochure available online at geha.com/PlanBrochureDental

2023 GEHA dental plans

geha.com | 877.590.4342

Coverage details for three common major dental services

Orthodontic coverage

Dental implant coverage

Night guard 1 coverage

Coverage detail

Age limit for both dental plans

Members age 13 or older

None

Waiting period

None

Services not covered

Cosmetic treatment or orthodontic work in progress is not covered (except for members with orthodontics that started under TRICARE).

Any service associated with implants not

Guards used to treat temporomandibular joint dysfunction (TMJ) are not covered.

specifically listed in the plan brochure is not covered.

2023 GEHA dental plans

Vision discounts included with both dental plans

With GEHA dental plans, you get discounts on eye exams, frames, and lenses through EyeMed. ® There is no limit on the number of discounted glasses or conventional contacts you may purchase each year. The EyeMed network includes Independent Provider Network, LensCrafters, Pearle Vision, Target Optical, contactsdirect.com , glasses.com and more. Members also save on LASIK at participating US Laser Network locations.

Learn more at geha.com/Vision Examples of common vision services and what you will pay at an EyeMed network location: Vision services in-network You pay Routine annual eye exams $5 Eyeglass lens: UV treatment Eyeglass lens: Tint (solid and gradient) Eyeglass lens: Standard plastic scratch coating $15

$40

Eyeglass lens: Standard polycarbonate

$45

Eyeglass lens: Standard anti-reflective coating

Up to $50

Eyeglass lenses (pair) standard plastic single vision

Up to $70

Eyeglass lenses (pair) standard plastic bifocal

Up to $105

Eyeglass lenses (pair) standard plastic trifocals

Up to $135

Eyeglass lenses (pair) standard progressive lens

60% of retail price

Frames

80% of retail price

Eyeglass lens: Photochromatic/transitions plastic

85% of retail price

Conventional contact lenses

Disposable contact lenses

Not covered

Out-of-network , the plan will reimburse $45 per covered member, per year, for routine annual eye exams. No out-of-network coverage for other services. These benefits are neither offered nor guaranteed under contract with the FEDVIP program, but are made available to all Enrollees who become members of GEHA and their eligible family members.

2023 GEHA dental plans

Included benefits & discounts

Electric toothbrush discount 1,2 Enjoy 70% off a cariPRO ® premium electric toothbrush. geha.com/Toothbrush

Teeth whitening discounts 1 Get a 20% discount on the lowest published price on all Smile Brilliant ® home teeth whitening and oral care products. geha.com/Whitening

Hearing aid discounts 1 Get discounts through TruHearing ® on hearing aids. Save up to 30% to 60% off hearing aids. Some average more than $2,600 in savings per pair. geha.com/Hearing

Medical alert system discount 1 Get free activation on Life Alert ® services, plus a 10% monthly discount, for you and your extended family. geha.com/LifeAlert

1 These benefits are neither offered nor guaranteed under contract with the FEDVIP program, but are made available to all Enrollees who become members of GEHA and their eligible family members. 2 The cariPRO ® premium toothbrush removes seven times more plaque than a regular brush, is completely waterproof and comes with a two-year manufacturer’s warranty. Replacement brush heads with high-quality DuPont TM bristles are also available at this exclusive, member-only price.

This is a brief description of the features of the GEHA Connection Dental Federal Plan. Before making a final decision, please read the Plan’s Federal brochure, available at geha.com/PlanBrochureDental

2023 GEHA dental plans

Step 1: Use your ZIP code to find your rate code Find your state and the first three digits of your ZIP in the chart below to determine your rate code. Use that code on the next page to determine your 2023 dental premium. geha.com/DentalRates

First 3 digits of ZIP code

Rate code

First 3 digits of ZIP code

Rate code

First 3 digits of ZIP code

Rate code

State

AL, AR, GU, IA, MS, ND, NE, PR, VI ID, LA, MO, MT, NC, OK, SC, SD, TN, UT, VT DE, HI, NM, OR CO, DC, NH, RI

Rest of state

Rest of state 1

Entire state or territory

430-433, 437, 440-443, 446, 447, 450-455, 459

660-662, 666

Rest of state 1

410

OH Rest of state

Entire state

Rest of state 1

172-174

MA 012

180-181, 183

Entire state or territory

Rest of state 4

189-196

205-212, 214, 216, 217

PA Rest of state

Entire state

755-759, 763- 769, 776-779, 783-785, 788- 799, 885 733, 786-787

MD 219

AK AZ AZ

Entire state

5 3

850-853, 864

Rest of state 2

039-042

900-931, 933- 935, 939-952, 954, 956-959

Rest of state

Rest of state 3

201, 203, 205, 220-227

480-485

CA CT CT

Rest of state 4

Rest of state 2

VA Rest of state

064-069

MN 3 MN Rest of state 2 NJ 080-084 3 NJ Rest of state 5 NV 897 5 NV Rest of state 3 550-555, 563

Rest of state 4

WA 980-985

FL FL

329-334, 349

986

Rest of state 2

WA Rest of state

300-303, 305, 306, 311, 399

540

Rest of state 2

Rest of state

IL IL IL

600-609, 613

3 2

WV 254

620, 622

WV Rest of state

005, 100- 119,124-126

Rest of state 1

834

460-462, 470, 472, 473

063

Rest of state

127, 129-139, 144-149

463,464

INTL All international

2023 GEHA dental plans

Step 2: Use your rate code to find your 2023 premium

geha.com/DentalRates

Employed – biweekly High premium

Rate code 1 1

Rate code 2 1

Rate code 3 1

Rate code 4 1

Rate code 5 1

$17.25

$19.40

$21.21

$23.70

$25.69

Self Only

$34.50

$38.79

$42.42

$47.40

$51.39

Self Plus One

$51.76

$58.19

$63.63

$71.10

$77.08

Self and Family

Employed – biweekly Standard premium

Rate code 1 1

Rate code 2 1

Rate code 3 1

Rate code 4 1

Rate code 5 1

$9.53

$10.69

$11.71

$13.07

$14.15

Self Only

$19.07

$21.37

$23.37

$26.10

$28.30

Self Plus One

$28.59

$32.06

$35.06

$39.16

$42.44

Self and Family

Retired – monthly High premium

Rate code 1 1

Rate code 2 1

Rate code 3 1

Rate code 4 1

Rate code 5 1

$37.38

$42.03

$45.96

$51.35

$55.66

Self Only

$74.75

$84.05

$91.91

$102.70

$111.35

Self Plus One

$112.15

$126.08

$137.87

$154.05

$167.01

Self and Family

Retired – monthly Standard premium

Rate code 1 1

Rate code 2 1

Rate code 3 1

Rate code 4 1

Rate code 5 1

$20.65

$23.16

$25.37

$28.32

$30.66

Self Only

$41.32

$46.30

$50.64

$56.55

$61.32

Self Plus One

$61.95

$69.46

$75.96

$84.85

$91.95

Self and Family

1 Rates based on member’s primary state of residence.

2023 GEHA dental plans

Definitions

Term

Definition

BENEFEDS is the government-authorized and U.S. Office of Personnel Management (OPM)-sponsored enrollment portal that eligible participants use to enroll in the Federal Employees Dental and Vision Insurance Program (FEDVIP). benefeds.com

BENEFEDS

Calendar year deductible

What you pay each year before the plan begins to pay out benefits.

Calendar year maximum

The maximum benefits that the plan will pay per person each calendar year.

Basic services that include preventive care such as oral exams, cleanings, diagnostic services, sealants and radiographic images.

Class A services

Intermediate services that include restorative procedures such as fillings, prefabricated stainless steel crowns, periodontal scaling, tooth extractions and denture adjustments. Major services that include endodontic services such as root canals, periodontal services such as gingivectomy, major restorative services such as crowns, oral surgery, bridges, implants and prosthodontic services such as complete dentures.

Class B services

Class C services

Class D services

Orthodontic services (braces).

Coinsurance

The percentage of covered expenses you must pay.

Any procedure or portion of a procedure performed primarily to improve physical appearance or performed for psychological purposes.

Cosmetic procedure

Any licensed dentist who is a part of GEHA’s provider network. To search for a provider, visit geha.com/Find-Care

In-network provider

The maximum benefits that the plan will pay per person. Orthodontic care on our Standard and High plans is subject to a lifetime maximum.

Lifetime maximum

The maximum amount the plan will pay for a specific procedure. The plan allowance may vary by geographic location and/or an in-network provider’s contracted fee schedule. When you use an out-of-network provider, you are responsible for the difference between the plan’s payment amount and the provider’s billed amount.

Plan allowance

The total amount paid to an insurance company for coverage, typically paid biweekly or monthly.

Premium

Visit geha.com/GetInTouch for ways to connect with a GEHA Benefits Adviser.

2023 GEHA dental plans

Helpful resources

Call us Talk with a helpful GEHA Benefits Adviser. 877.590.4342

Compare plans Easily compare GEHA’s High and Standard dental plans. geha.com/CompareDental

Find a provider Find a dentist or see if yours is in-network. geha.com/Find-Care

Estimate costs See if a dental service is covered and estimate how much you will pay for those services. geha.com/DentalPricing

Check rates for 2023 geha.com/DentalRates

Get in touch Let us help you choose a GEHA plan that can work for you.

geha.com

2023 GEHA dental plans

STANDARD US POSTAGE PAID GEHA

PO Box 21542 | Eagan, MN 55121-9930

Please Recycle

GEHA has a dental plan for your needs Let us help you choose a plan that can work for you.

Ready to enroll? Visit benefeds.com and follow the prompts to enroll in GEHA Connection Dental Federal. Call BENEFEDS toll-free at 877.888.3337 TTY: 877.889.5680

Download the plan brochure. For information and changes, see the official, detail-filled plan brochure at geha.com/PlanBrochureDental

geha.com | 877.590.4342

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